Surgical Treatment of Coronary Subclavian Steal Syndrome with Carotid Subclavian Bypass

Coronary subclavian steal syndrome (CSS) results from proximal subclavian artery occlusive disease causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass leading to myocardial ischemia. Although percutaneous transluminal angioplasty and stent (PTAS) for subclavian lesions has been successful, it is not always feasible. In this study, the results of carotid subclavian bypass (CSB) for symptomatic CSS due to subclavian occlusion and stenosis not amenable to PTAS were analyzed. The records of patients undergoing CSB for CSS between 1991 and 2001 were reviewed. Patients with lesions not amenable to angioplasty or stent were selected for CSB. Degree of preoperative myocardial ischemia was stratified according to New York Heart Association classification. Graft patency was analyzed by life-table methods. Our results showed that CSB for treatment of symptomatic CSS can be performed safely with excellent mid-term durability. In the setting of proximal subclavian artery disease not amenable to PTAS, CSB provides an acceptable means of treatment for symptomatic CSS.